The number of NPs in the United States increased more than twofold between 2010 and 2017, according to a study published Monday in Health Affairs.

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Study finds surge in NP workforce

For the study, researchers analyzed data from the U.S. Census Bureau's American Community Survey to examine changes among NP demographics, employment, and earnings from 2010 to 2017.

The researchers found the number of NPs in the United States increased by 109% over that time, rising from 91,000 in 2010 to 190,000 in 2017. In comparison, the researchers found the number of physicians in the United States increased by 9%, from 870,000 in 2010 to 950,000 in 2017. And those trends don't appear to easing any time soon: The researchers projected the NP workforce will grow at a faster rate than the PA and physician workforces—at 6.8%, 4.3%, and 1.1%, respectively—from 2016 to 2030.

According to the researchers, NP employment was concentrated among hospitals, physician offices, and outpatient care centers from 2010 to 2017, and grew the fastest in the outpatient setting:

The researchers also found that average annual earnings for full-time NPs varied by care setting:

According to the researchers, NPs' average inflation-adjusted earnings increased by 5.5% from 2010 to 2017. David Auerbach, lead author of the study and an adjunct faculty member at Montana State University, said the increase suggests there is a healthy demand for NPs.

What's driving the growth in NPs?

The researchers attributed the increase in NPs to a rapid expansion of education programs designed to attract millennial nurses. According to the researchers, the number of education programs for NPs increased from 356 in 2010 to 467 in 2017.

Federal and state regulations and programs also have helped to drive the increase in NPs, the researchers said. Peter Buerhaus, a co-author of the study and a professor of nursing at Montana State University, said the Affordable Care Act "elevated the role of PAs and NPs," and the Health Resources and Services Administration's NP education "programs … provided a jolt of energy" for the workforce.

In addition, states "loosened regulations on scope-of-practice laws" for NPs, Buerhaus said.

What the growth in NPs means for care delivery

The growing number of NPs and new scope-of-practice laws has enabled NPs to play a greater role at hospitals and health systems under value-based payment arrangements and in primary care, particularly in rural regions of the United States.

Auerbach said, "The relative low growth in the physician workforce is creating a gap in primary-care access and [NPs] are filling that gap," which "has big implications for primary care." He explained, "A lot more people will be getting care from NPs."

And notably, the researchers found that the increase in NPs from 2010 to 2017 came as the number of RNs shrank by up to 80,000. The researchers noted that "most NPs practice as RNs before completing their education to become an NP," leaving a gap in the RN workforce.

That reduction has put pressure on hospitals and policymakers to implement strategies to fill a new void of RNs in the U.S health care system. The researchers said hospitals will have to innovate and test new ideas to replace RNs who have become NPs. They noted, "The potential loss of RNs to the NP workforce is likely to continue to cause employment ripples, particularly in acute care settings" (Kacik, Modern Healthcare, 2/3; Japsen, Forbes, 2/3; Auerbach et al., Health Affairs, February 2020).